June 24, 2016

DOJ Catch of the Week — Medicare Fraud Strike Force

By the C|C Whistleblower Lawyer Team

This week’s Department of Justice “Catch of the Week” goes to the 301 medical professionals that were the target of Wednesday’s government healthcare fraud takedown involving roughly $900 million in alleged fraudulent Medicare and Medicaid billings.  The “unprecedented nationwide sweep” was led by the Medicare Fraud Strike Force and included the Medicaid Fraud Control Units of 23 states.  It is the largest coordinated healthcare fraud enforcement action in history, both in terms of the number of defendants charged and the losses alleged.  See DOJ Press Release

According to the government, the various defendants engaged in multiple health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft.  These alleged crimes involve a wide variety of medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs.  More than 60 of the defendants arrested are charged with fraud related to the Medicare Part D prescription drug program, which is the fastest-growing component of the Medicare program overall.  The defendants allegedly participated in these schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.

In announcing the takedown, Attorney General Loretta Lynch stressed the serious nature of healthcare fraud and how stopping it is one of the government’s top enforcement priorities:

As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime.  The wrongdoers that we pursue in these operations seek to use public funds for private enrichment.  They target real people – many of them in need of significant medical care.  They promise effective cures and therapies, but they provide none.  Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends.  The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.

FBI Associate Deputy Director David Bowdich echoed this sentiment in noting that “these criminals target the most vulnerable in our society by taking money away from the care of the elderly, children and disabled.  He stressed his agency’s commitment “to stop fraud and ensure that healthcare dollars are used to help the sick, and not line the pockets of criminals.”

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